Tuesday, March 16, 2010

Conservatives Unwittingly Promote a Single Payer System

After reading the final sentence of my most recent post on health reform, friends asked me what I'd been smoking:

"Therefore, since health care costs must be constrained, whether through federal legislation this year or, if that fails, when the U.S. economy implodes further, the paradoxical result of the conservative anti-mandate fervor is that we will ultimately need an out-of-the-closet tax. Single payer - here we come!"

In today's New York Times, William Pewen, a former health policy advisor to Republican Senator Olympia Snowe, argues that bipartisan reform was potentially achievable, but faulty leadership from both parties blew it. Pewen is evenhanded in his critique of the parties. (I would put more blame on the Republicans, who took Nancy Reagan's injunction to "just say no" to drugs as their marching orders in relation to President Obama!)

But what interested me most was that Pewen reached the same conclusion I did about where failure of today's reform effort will lead us tomorrow:

"Should they succeed in blocking reform, Republicans should take no consolation. When Congress next attempts reform, in a decade or more, health costs and the number of uninsured and underinsured will have escalated — and the likely outcome will be the single-payer system that Republicans most abhor."

I have the privilege of directing the ethics program at Harvard Pilgrim Health Care, a non profit insurer in Massachusetts, New Hampshire and Maine (Senator Snowe's state) that currently provides health insurance to 1.1 million. (U.S. News and World Report has ranked Harvard Pilgrim first among commercial insurers for the past five years.) I know first hand that private insurers can comport themselves in an ethically admirable manner.

But if a society were creating a health system from scratch, it's hard to imagine that it would develop a hodgepodge like what we have today in the U.S. Some form tax supported universal coverage, whether single payer or the kind of system Zeke Emanuel envisioned in "Healthcare, Guaranteed," would be much more likely.

More than a hundred years ago Sigmund Freud hypothesized that repressing our true objectives would lead to "return of the repressed," in symptoms, Freudian slips, and the like. Perhaps that's what we'll see in the U.S. Conservative political discourse is trying to "repress" communitarian values by accusing communitarians of plotting "death panels" and "socialized medicine." It won't work. Pewen and I both see the rabid forms of opposition to health reform as the last gasp of a political neurosis.

As Winston Churchill said - "The Americans will always do the right thing . . . After they've exhausted all the alternatives!"